Advertisement

Which young adults are most likely to use withdrawal? The importance of pregnancy attitudes and sexual pleasure

  • Jenny A. Higgins
    Correspondence
    Corresponding authors. Tel.:+1 608 890 4622.
    Affiliations
    Department of Gender and Women's Studies, University of Wisconsin-Madison, 3414 Sterling Hall, 475 North Charter St, Madison WI 53706, USA
    Search for articles by this author
  • Yu Wang
    Correspondence
    Corresponding authors. Tel.:+1 608 890 4622.
    Affiliations
    Department of Sociology, University of Wisconsin-Madison, 4412 William Sewell Social Sciences, 1180 Observatory Drive, Madison WI 53706, USA
    Search for articles by this author

      Abstract

      Objectives

      Use of withdrawal (coitus interruptus) has consequences for reproductive health, but few nationally representative studies exist. We (1) examined patterns of withdrawal among 15- to 24-year-old women and men, and (2) explored withdrawal's associations with sociodemographic, psychological, and sexual factors.

      Study design

      Using data from the 2006–2010 National Survey of Family Growth, we assessed reports of any and only withdrawal use at last sexual episode in the last month from 3517 sexually active 15 to 24 year-old women and men at risk of unintended pregnancy. Logistic regression documented associations with withdrawal.

      Results

      Fourteen percent of young women and 17% of young men reported any use of withdrawal at last sex; 7% and 6%, respectively, reported only use of withdrawal. Though associated with few sociodemographic factors, withdrawal was significantly linked with pregnancy- and condom attitudes. In regression models, compared to those who said they would be upset if they discovered they were pregnant, young women who said they would be pleased about a pregnancy were 2.2–2.6 times as likely to have used any/only withdrawal (p<.01). For both women and men, those who felt that condoms were likely to diminish sexual pleasure were more likely to have used any/only withdrawal (odds ratio=1.8–2.6, p<.05).

      Conclusions

      At their last sexual episode, a greater proportion of young adults used withdrawal in conjunction with other methods than by itself. The psychological and sexual variables of orientation toward pregnancy and attitudes about condoms and pleasure were more strongly linked with withdrawal practices than most sociodemographic variables.

      Implications statement

      Since a substantial minority of young adults use withdrawal, providers may wish to speak directly to contraceptive clients about this method, though they should distinguish between only versus any withdrawal use. Practitioners may also be well served by assessing and responding to pregnancy orientation and pleasure attitudes in contraceptive counseling.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mosher W.D.
        Use of contraception in the United States: 1982–2008.
        DHHS publication no. (PHS) 2010–1981. National Center for Health Statistics, 2010 ([Contract No.: 29])
        • Doherty I.A.
        • Stuart G.S.
        Coitus interruptus is not contraception.
        Sex Transm Dis. 2011; 38: 356
        • Miller R.
        Withdrawal: “A very great deal better than nothing”.
        Can J Hum Sex. 2003; 12: 189-190
      1. American Congress of Obstetricians and Gynecologists.
        • Centers for Disease Control and Prevention
        • Jones R.K.
        • Lindberg L.D.
        • Higgins J.A.
        Pull and pray or extra protection? Contraceptive strategies involving withdrawal among US adult women.
        Contraception. 2014; 9: 416-421
        • Sznitman S.R.
        • Romer D.
        • Brown L.K.
        • DiClemente R.J.
        • Valois R.F.
        • Vanable P.A.
        • et al.
        Prevalence, correlates, and sexually transmitted infection risk related to coitus interruptus among African-American adolescents.
        Sex Transm Dis. 2009; 36: 218-220
        • Dude A.
        • Neustadt A.
        • Martins S.
        • Gilliam M.
        Use of withdrawal and unintended pregnancy among females 15–24 years of age.
        Obstet Gynecol. 2013; 122: 595-600
        • Greene M.E.
        • Biddlecom A.E.
        Absent and problematic men: demographic accounts of male reproductive roles.
        Popul Dev Re. 2000; 26: 81-115
        • Berer M.
        Male circumcision for HIV prevention: perspectives on gender and sexuality.
        Reprod Health Matters. 2007; 15: 45-48
        • Higgins J.A.
        • Popkin R.A.
        • Santelli J.S.
        Pregnancy ambivalence and contraceptive use among young adults in the United States.
        Perspect Sex Reprod Health. 2012; 44: 236-243
        • Gray A.
        • Chowdhury J.H.
        • Caldwell B.
        • Al-Sabir A.
        Coitus-dependent family planning methods: observations from Bangladesh.
        Stud Fam Plan. 1999; 30: 43-53
        • De Visser R.
        Delayed application of condoms, withdrawal and negotiation of safer sex among heterosexual young adults.
        AIDS Care. 2004; 16: 315-322
        • Finer L.B.
        • Henshaw S.K.
        Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
        Perspect Sex Reprod Health. 2006; 38: 90-96
        • Lepkowski J.
        • Mosher W.
        • Davis K.
        • Groves R.
        • Van Hoewyk J.
        The 2006–2010 National Survey of Family Growth.
        Sample design and analysis of a continuous survey. National Center for Health Statistics, Hyattsville, MD2010 ([Contract No.: 150])
        • Groves R.
        • Mosher W.
        • Lepkowski J.
        • Kirgis N.
        Planning and development of the continuous National Survey of Family Growth.
        Vital Health Stat. 2009; 1: 1-64
        • Graham C.A.
        • Catania J.A.
        • Brand R.
        • Duong T.
        • Canchola J.A.
        Recalling sexual behavior: a methodological analysis of memory recall bias via interview using the diary as the gold standard.
        J Sex Res. 2003; 40: 325-332
        • Weinhardt L.S.
        • Forsyth A.D.
        • Carey M.P.
        • Jaworski B.C.
        • Durant L.E.
        Reliability and validity of self-report measures of HIV-related sexual behavior: progress since 1990 and recommendations for research and practice.
        Arch Sex Behav. 1998; 27: 155-180
        • Jones R.K.
        • Fennell J.
        • Higgins J.A.
        • Blanchard K.
        Better than nothing or savvy risk-reduction practice? The importance of withdrawal.
        Contraception. 2009; 79: 407-410
        • Whittaker P.G.
        • Merkh R.D.
        • Henry-Moss D.
        • Hock-Long L.
        Withdrawal attitudes and experiences: a qualitative perspective among young urban adults.
        Perspect Sex Reprod Health. 2010; 42: 102-109
        • Higgins J.A.
        • Hirsch J.S.
        • Trussell J.
        Pleasure, prophylaxis and procreation: a qualitative analysis of intermittent contraceptive use and unintended pregnancy.
        Perspect Sex Reprod Health. 2008; 40: 130-137
        • Higgins J.A.
        • Gregor L.
        • Mathur S.
        • Nakyanjo N.
        • Nalugoda F.
        • Santelli J.S.
        Use of withdrawal (coitus interruptus) for both pregnancy and HIV prevention among young adults in Rakai, Uganda.
        J Sex Med. 2013; 11: 2421-2427
        • Higgins J.A.
        • Davis A.R.
        Sexuality and contraception (chapter 1).
        in: Hatcher R.A. Contraceptive technology. 20th ed. Ardent Media, New York, NY2011: 1-28
        • Bellanca H.K.
        • Hunter M.S.
        ONE KEY QUESTION(R): preventive reproductive health is part of high quality primary care.
        Contraception. 2013; 88: 3-6
        • Bello J.K.
        • Adkins K.
        • Stulberg D.B.
        • Rao G.
        Perceptions of a reproductive health self-assessment tool (RH-SAT) in an urban community health center.
        Patient Educ Couns. 2013; 93: 655-663
        • Fortenberry J.D.
        • Tu W.
        • Harezlak J.
        • Katz B.P.
        • Orr D.P.
        Condom use as a function of time in new and established adolescent sexual relationships.
        Am J Public Health. 2002; 92: 211-213